Development and validation of a dynamic nomogram for dentes cariosus in Chinese children

Objectives: This study is to examine the factors associated with dentes cariosus in Chinese children. Furthermore, we construct a risk prediction nomogram and assess its predictive performance. Methods: A total of 450 Chinese children who visited the outpatient Department of Stomatology, General Hospital of Northern Theater Command were included in this study. The patients were divided into dental caries group (n = 340) and non-caries group (n = 110) based on the presence of dental caries at presentation. Independent predictors of dental caries were determined using univariate and multivariate logistic regression analyses combined with LASSO regression. The prediction model was established by a nomogram model based on three factors and the original dataset was also used for validation. The discriminative power was measured by the receiver operating characteristic (ROC) curve’s area under the curve (AUC), whereas calibration was assessed using calibration plots and the Hosmer-Lemeshow test. Clinical applicability was examined through decision curve analysis (DCA) and clinical impact curves (CIC). Results: The following three factors contribute to the occurrence of dental caries: liking to eat snacks, bad behavior habits and brushing teeth for less than 2 minutes. The predicted probabilities of dental caries in outpatient clinics corresponded well to the actual incidence with index of the bootstrap-corrected Harrell's concordance was 0.939 [95% CI, 0.910-0.964] and the P value of the Hosmer-Lemeshow test was 0.922. Decision curve analysis demonstrated that our predictive model offered greater net clinical benefit across threshold probabilities of 1% to 70% compared to either no intervention or universal intervention strategies. CIC displayed good predictive ability and clinical application value for the model. Conclusion: Prediction nomograms, which including a simple clinical nomogram and online dynamic nomogram, can be used to identify children susceptible to dental caries. Thus, it is better for dentists to provide individualized management and timely and effective intervention measures for children at high risk of caries.